Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | R220828 | MD |
NPI | 1003571092 |
---|---|
Provider Name | Ms. Docia Owusu |
First Address | Silver Spring, MD 20904-4931 |
Second Address | Glen Burnie, MD 21060-8312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2021 |
Last Update Date | 03/11/2021 |